Common Ophthalmic DisordersGauri S. Shrestha, M.Optom, FIACLE Assistant Lecturer BPKLCOS
Chalazion• Chalazion is a chronic and focal granulomatous inflammation of the meibomian gland• Symptoms – Painless swelling in the lid, occasionally blurring of vision from induced astigmatism, watering• Signs – well defined subcutaneous nodule in the eyelid. – non-tender swelling slightly away from the lid margin.• Treatment – Hot compression, antibiotic massage, surgery
Stye• A focal, acute, and suppurative inflammation of glands of Zeis or Moll at the lid margins.• Symptoms – Acute pain associated with swelling of lid, mild watering and photophobia, tenderness.• Signs – Localized erythema, tender, swelling at the lid margin – A pus point associated with the affected cilia.• Treatment: – Hot compression, epilation, antibiotics
Bleharitis• A subacute or chronic inflammation of the lid margins and the lashes.• A lifelong condition, difficult to eradicate, and requires constant vigilance to restrain its irritating manifestations.• Symptoms: mild discomfort, irritation, mild watering and falling eyelashes gluing of cilia.• Signs: Dandruff like scales on the lid margin, thickening, hyperemia of cilia, crusting.• Treatment: lid scrub, topical antibiotics, lubricating eye drops
Dacryocystitis• Dacryocystitis refers to inflammation of the lacrimal sac.• Symptoms – Pain, redness and swelling in the innermost aspect of the lower lid, tearing, discharge or fever.• Signs – Erythema, tender, tense swelling centred over the nasal aspect of the lower eyelid and extending around the periorbital area nasally. – Mucoid or mucopurelent discharge can be expressed from the punctum when pressure is applied over the lacrimal sac.
Orbital cellulitis• It is a suppurative inflammation of the cellular and adipose tissue of the orbit. It is a life threatening infection.• Symptoms: Unilateral pain, swelling, fever, nausea, vomiting, blurred vision, headache, and double vision.• Signs: – Proptosis or restriction of ocular motility, decreased vision. – Eyelid edema, erythema, warmth, tenderness. – A marked chemosis and congestion of conjunctiva. – Lacrimal gland enlargement or palpable orbital mass. – Increased IOP, optic nerve swelling or atrophy, congestion of retinal veins.
Orbital cellulitis• Treatment – Systemic and topical antibiotics, analgesics, surgery
Pterygium• A wing shaped and triangular fibrovascular subepithelial ingrowth of degenerative bulbar conjunctival tissue over the limbus and the cornea.• Symptoms – May be asymptomatic, irritation, redness, decreased vision• Signs – A small, grey, corneal opacity develops near the nasal or temporal limbus. – Wing shaped fold of fibrovascular tissue arises from the interpalpebral conjunctiva over the opacity and progressively encroaches onto the cornea.• Treatment – Lubricating eye drops, surgery
Conjunctivitis• Conjunctivitis is an inflammation of conjunctiva caused by bacteria, virus, allergy (hypersensitivity), or exposure to irritants (acids, ammonia, lime, silver nitrate, copper sulphate).• Symptoms – Redness, discomfort and foreign body sensation – Burning and gritty sensation and itching (typically in allergy) – Mild photophobia i.e. difficulty to tolerate light. – Discharge or sticking together of lid margins during sleep (typical in bacterial). – Swelling of lids.
Ophthalmia Neonatorum• Ophthalmia neonatorum refers to bilateral inflammation of the conjunctiva occurring in an infant less than 30 days old.• It is also called as newborn conjunctivitis.• Symptoms – Conjunctival discharge, watering, swelling of eyelids, and red eye• Signs – Conjunctival discharge: It is purulent in Gonococal ophthalmia neonatorum, mucopurulent in other bacterial cases in the first month of life. – Conjunctiva: diffuse conjunctival congestion and chemosis. – Cornea: superficial punctate ketatitis.
Bacterial Corneal ulcer• Corneal ulcer refers to discontinuation of normal epithelial surface of cornea associates with necrosis of the surrounding corneal tissue.• Symptom: foreign body sensation, photophobia, blurring of vision, pain, eyelid edema, and discharge• Signs: – conjunctival and circumcorneal congestion, – an epithelial defects associated with an infiltrate – corneal edema, sterile anterior uveitis with hypopyon.
Fungal corneal Ulcer• Fungal infection may have devastating effects due to capability to cause stromal necrosis and penetrate the anterior chamber by penetrating an intact Descement membrane.• Symptoms – Similar to bacterial corneal ulcers however it is less marked than the equal size of bacterial ulcer.• Signs – Dry greyish white with elevated rolled out margin. – Delicate feathery extension into the surrounding stroma under the intact epithelium. – Multiple satellite leasions around the ulcer. – A sterile yellow line of demarcation is present. – Usually hypopyon is present.
• Treatment• Topical eye drop/ fortified• Subconjunctival injection of antibiotics,• System antibiotics• Antifungal agents (fungal)
Glaucoma• Lecture on Glaucoma• Lecture on Cataract
Diabetic retinopathy• It refers to the retinal changes happen in diabetic melitus.• Diabetic retinopathy is more common in type I (40%) than type II (20%).• Symptoms – Gradual diminution of vision, frequent change in spectacle lens, glare• Signs – Haemorrhage (dot and blot shaped), microaneurisms, hard exudates – cotton wool spots, venous beading, and looping, moderate capillary non-perfusion, Neovascularization
Diabetic retinopathy• Treatment• Control blood sugar• Photocoagulation• Vitro-retinal surgery